ASCLEPIADS A.H.O.A. INTERNATIONAL

Membership Application Form

I wish to join ASCLEPIADS INTERNATIONAL and am applying to be a Candidate, Associate or Client. I understand that this obligates me to pay $20.00 now and $15.00 per month dues as an Associate or Client. If applying for Candidacy, I enclose $150.00 and will pay $15.00 per month, which covers processing and postage costs while I remain a member in this category.

  ASSOCIATE/CLIENT
USA: $20 now + $15 per Month
  CANDIDATE
USA: $150 + $15.00 per Month
 

YOUR FULL NAME
ADDRESS
CITY
STATE
ZIP
EMAIL ADDRESS

Please Print Out and Mail to: A.H.O.A.  PO Box 95, Calumet City, IL 60409
Email us if you have any questions.

Thank You!